First, my gut feeling is (w/o knowing anything about the domain really): You may well be exactly right to ask outsiders as the profession itself may well have evolved into a suboptimal/too pragmatic (not to say 'opportunistic') treatment of such questions, given a constant pressure from suboptimal legal code & practice. In totally different areas I constantly see supposedly highly professional domain-bodies being utterly flawed from social/rational/economic perspective, and would easily expect this to be the case in your domain too.
Now, I'm assuming:
FWIW: I would find the following relatively natural or 'rational' - even if as a recipe maybe too high-level/trivial - though maybe I'm being too superficial and just stating a few all too obvious points and ignore too many subtleties of the domain..:
The one LW-y thing to add that comes to mind: Factor in AIs in all points above. Might soon 'I've consulted Claude10.9 and he assured me it's better' suddenly count as better evidence than asking any human? ;-). Might Claude 11.1 anyway kick you out of job by 2028 at the latest so you can downweight your career risk from helping (though not downweight the risk of jailtime)?
* I fear that in practice as one gets older and less idealistic/more pragmatic, it would not be too rare that a simple self-serving bias creeps in, making also psychologists want to treat patients simply because that is how they earn their money (even if they might not internally frame it exactly that way)?! Please make sure you get to know many practitioners intimately and come back in 20 years to this blog and tell what your impression is :-)
I would second most of what @FlorianH said, though not necessarily the specific procedure. The general idea of actually weighing the relative harms and their likelihoods, and comparing the results, is the key to resolving these kinds of conflicts. Although you probably shouldn't keep records of doing that, since most people and legal systems don't like anyone explicitly assigning lives a specific finite value.
In your suicidal young girl scenario, what does it actually mean, specifically, to not be technically competent? Is there a particular certification you're required to have to perform some specific therapy? That seems plausible, but also, as a professional you're well aware that there are many approaches to helping any given person that are all better than nothing, and you can avoid ones you're not comfortable with. Even having a conversation with a non-professional is well known, in the literature, to be significantly better than nothing, and in many cases close to as good as talking to a professional (for any number of reasons).
Is there some certification required to work with such a person at all? That seems... implausible? Odd? It seems like any rule that says something like that is more like how you should see a dermatologist instead of having your primary care doctor treat a rare skin condition. If every local dermatologist has a six month waiting list for an appointment, your regular doctor should absolutely be willing to help you, and make a phone call to consult with colleagues as needed. Even if there's no one else in your town or remotely available to actually care for this person, there's nothing preventing you, the professional, from consulting with more distant colleagues between sessions, with patient approval.
You may also be legally required to report this to the girl's parents, whether you treat her or not.
You may have a way to involuntarily commit this girl, in which case there is likely to be some authority that has the resources and obligation to move her to a place that can provide more intensive care.
Beyond that, even if you're motivated primarily by professional self-interest and lawsuits, consider the two scenarios, where a girl has died and you're being sued or charged. In which case would you expect the judge or jury to be more lenient? The one where you turned her away out of fear of impacts on your career? Or the one where you exhausted all of the known-to-be inadequate options available?
And I would also say, take a really close look at how the ethical standards you're officially held to are actually written, but without getting lost in the weeds of vague wording. Consider the APA's Code of Ethics. Consider that things were written in a specific order, for a reason. Right in the Preamble: "This Ethics Code is intended to provide specific standards to cover most situations encountered by psychologists." Most, not all. Also in the Preamble: "The development of a dynamic set of ethical standards for psychologists' work-related conduct requires a personal commitment and lifelong effort...to consult with others concerning ethical problems." Then, before getting into any specific guidelines, you also have a set of general principles that are the standard kinds of Virtue Ethics exhortations to be caring and humane. The actual rules that attempt to operationalize all of this come after that. Usually, this means what came before is intended as the frame through which you're meant to interpret and adjudicate what comes later.
Also also, if you go way back to the early days of LessWrong, EY wrote a post, Prices or Bindings?, as part of a longer ethics sequence (you may want to read that sequence and the comments). It gets into when ethical injunctions should be absolute, and when not, and why. Ideally you consider not just the implications of your actions for yourself and this girl, but on all other people, everywhere, forever. Humans can't actually compute that, but we can try to approximate it using fundamental values as guideposts. What is it you, personally, actually care most about? And why? What plans and choices actually, in practice, are likely to lead to a world where whatever you care about flourishes?
The way I spend most of my day right now is as a student studying neuropsychology. I'm a fourth year, mature age student, and something has come up recently which made me think this community might have something to offer—how do people make choices relating to ethical dilemmas.
I’m doing a course now focused on solving ethical dilemmas within psychological practice. The reason this is heavily taught is that psychologists are often tied up in ethical problems which lead to lawsuits, getting de-registered, or even arrested. The occurrence numbers are quite high for all kinds of weird ethical issues. As you can imagine, there are all instances of boundaries which can be crossed, violated, dual relationships, misrepresenting competences, and sometimes, sadly, people die. So lawsuits and testifying before panels about the care which is given is not uncommon. Ergo, navigating ethical dilemmas can have large consequences.
At the core of many of these dilemmas are tensions between specifics within the code of ethics for psychological practice. I'm sure these codes vary from country to country broadly. But lets say you are not technically competent in working with depressed young girls especially around CBT therapies, but in your town, there are no other psychologists, and remote treatment is not possible—so its you or nothing. Technically, letter of the code, says this falls outside of your competence area, yet also, you have a duty of care to help prevent harm to this girl. So you can either practice outside of your competence, breaking one code, or ignore treatment for the girl entirely, breaking another code. There are probably better examples than this but ultimately, its just always the same thing, a tension between two elements of the code. Often, psychologists are sued because of choosing one path over the other. In the above example, you might treat the young girl, it doesn't pan out, she commits suicide, and the parent sues you. Or, you say its outside your competence, the girl feels helpless, and the same outcome occurs.
As the unit coordinators will say, there are lots of ways to navigate these ethical dilemmas, but something I notice is that the frameworks and formulas showcased are pretty vague. They resemble the kind of thing a management consultant might adopt. There doesn’t seem to be a lot of quantitative thinking here, and i’m curious what a rationalist less wrong approach might be in navigating dilemmas such as this. Obviously its difficult to answer a general question like this, but I'm imagining myself at the end of this whole learning journey, in practice, and it feels like most of the suggested ways of navigating these dilemmas could be vastly improved.
One method I’ve been given and seen is this Koocher & Keith-Spiegel (2008) eight step problem-solving model which goes something like this.
At each one of these steps, I just see countless amounts of room for interpretation and can imagine how psychologists could use something like this and still make suboptimal choices.
I’m just curious how outsiders to psychological practice might consider solving ethical tensions.
I can’t help but think that there must be a better more rationalist approach to these dilemmas that psychologists might not be considering because they are relying so heavily on supervision. One of the strategies they rely on a lot is to seek input from peers and supervisors who are competent. Yet as you would imagine, people, especially early career psychologists are more likely to seek council from people close to them, or people who say they are competent, not from some quantifiable measure of competence. its also unclear if someone new in practice can even evaluate competence. And this more or less is how many of the frameworks for solving ethic dilemmas in psychology seem to be. They seem more grounded in these rules of thumb, without considering if there is any correlation between the frameworks used, and the likelihood of causing less damage.
Anyway, its a bit of a random one, but just curious what members of this community might think about solving ethical dilemmas in psychology. It almost feels like there is some version of Doing Good Better (The Book) out there, but instead of it being about donating to charity, its about helping navigate psychological practice Trolly problems. I guess i'm asking, what might that book say? The whole space is very high stakes—lots of law suits, lots of deaths, lots of psychological harm—and it strikes me as odd that the frameworks for resolving the tensions seem very informal, even when presented as formal problem solving methods.